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Multicenter Study
. 2022 Feb;36(2):1466-1475.
doi: 10.1007/s00464-021-08431-z. Epub 2021 Mar 19.

Video-assisted thoracoscopic lobectomy after neoadjuvant chemotherapy for non-small cell lung cancer: a multicenter propensity-matched study

Andrea Dell'Amore  1 , Ivan Lomangino  2 , Nicola Tamburini  3 , Stefano Bongiolatti  4 , Nicola Sergio Forti Parri  5 , William Grossi  6 , Chiara Catelli  2 , Giulia Lorenzoni  7 , Dario Gregori  7 , Samuele Nicotra  2 , Andrea Zuin  2 , Angelo Morelli  6 , Piergiorgio Solli  5 , Luca Voltolini  4 , Giorgio Cavallesco  3 , Federico Rea  2
Affiliations
Multicenter Study

Video-assisted thoracoscopic lobectomy after neoadjuvant chemotherapy for non-small cell lung cancer: a multicenter propensity-matched study

Andrea Dell'Amore et al. Surg Endosc. 2022 Feb.

Abstract

Background: The role of video-assisted thoracoscopic surgery for the treatment of non-small-cell lung cancer after neoadjuvant chemotherapy remains controversial. The aim of this study is to demonstrate the reliability of video-assisted lobectomy compared to the open approach by evaluating perioperative and long-term outcomes.

Methods: In this retrospective, multicentric study from January 2010 to December 2018, we included all patients with non-small-cell lung cancer who underwent lobectomy through the video-assisted or open approach after neoadjuvant chemotherapy. The perioperative outcomes, including data concerning the feasibility of the surgical procedure, the occurrence of any medical and surgical complications and long-term oncological evidence, were collected and compared between the two groups. To minimize selection bias, propensity score matching was performed.

Results: A total of 286 patients were enrolled: 193 underwent thoracotomy lobectomy, and 93 underwent VATS lobectomy. The statistical analysis showed that surgical time (P < 0.001), drainage time (P < 0.001), days of hospitalization (P < 0.001) and VAS at discharge (P = 0.042) were lower in the VATS group. The overall survival and disease-free survival were equivalent for the two techniques on long-term follow-up.

Conclusions: VATS lobectomy represents a valid therapeutic option in patients affected by non-small-cell lung cancer after neoadjuvant chemotherapy. The VATS approach in our experience seems to be superior in terms of the perioperative outcomes, while maintaining oncological efficacy.

Keywords: Lobectomy; Minimally invasive thoracic surgery; Neoadjuvant chemotherapy; Non-small-cell lung cancer; VATS.

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Conflict of interest statement

Drs: Andrea Dell’Amore, Ivan Lomangino, Nicola Tamburini, Stefano Bongiolatti, Nicola Sergio Forti Parri, William Grossi, Chiara Catelli, Giulia Lorenzoni, Dario Gregori, Samuele Nicotra, Andrea Zuin, Angelo Morelli, Piergiorgio Solli, Luca Voltolini, Giorgio Cavallesco and Federico Rea have no conflict of interest or financial ties to disclose.

Figures

Fig.1
Fig.1
Propensity score matching protocol
Fig. 2
Fig. 2
Overall survival stratified for the two surgical approaches
Fig. 3
Fig. 3
A Comparison between the two techniques of stratified cumulative incidence analysis for cancer-related and non-cancer-related death. B Cumulative incidence of disease-free survival
See this image and copyright information in PMC

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